There are several ways
to set up a quality assurance program. For larger more complex
facilities it may be appropriate to hire a qualified medical
physicist to set up the quality assurance program for the
office. Please note: now that the new rule is
adopted, only those qualified medical
physicists who are certified by the Department, may perform
the annual quality control (qc) survey. For a list
of qualified medical physicists who are certified, click
here for download.

For smaller facilities
(and larger facilities if they choose) the Department has
developed Compliance Guidance Documents on how to set up and
carry out a quality assurance program. These guidance documents
include lists of equipment that may be needed, step-by-step
suggested guidance, sample forms, manuals, procedures, and
test methodologies. Please note: the Compliance Guidance
Documents are not regulatory standards. They are developed
as tools to assist the regulated community develop and implement
their Quality Assurance Program. The Department has developed
workshops to coincide with the implementation schedule as
stated in the quality assurance new rules.

The doctor, chiropractor,
technologist, or other appropriately trained person may perform
all of the daily, weekly, and monthly radiographic quality
control tests. A certified medical physicist must perform
the annual medical physicist's qc survey for radiographic,
fluoroscopic or CT scan equipment.

Many of the tests are
simple observations. For example, are the view box light bulbs
working or are the films and processor chemicals being stored
properly? Other tests involve a little more time such as performing
sensitometry and densitometry on a daily basis. These tests
take an average of 3 to 5 minutes. If a quality assurance
program is well designed and organized, the quality control
tests should not be burdensome.

You check cassettes
by doing a visual check looking for dents and warping. Check
to see that the cassette locks are functioning. You look at
films to see if there are light leaks. Light leaks from the
cassette will appear as dark areas in the same spot on most
films. You look at the screens for artifacts and you do a
screen/film contact test. For the details of these
procedures, click here to download the
Radiographic Compliance Guidance Document.

The quality control
procedure that monitors the processor is a key procedure and
has been written with much detail. For a complete and
detailed procedure on sensitometry/densitometry and film processor
quality control as delineated in the Radiographic Compliance
Guidance Document, click here to download.

19.
Why do I need to do the Sensitometry/Densitometry Test daily?
Why not weekly?

Sensitometry/Densitometrymust be done every day that x-rays are performed. Processing
is known to be the weak link in the production of radiographs.
It is the area of quality control that requires the most attention.
The photographic film is very sensitive to processing changes.
A processor that is out of control can negate the quality
control efforts in other areas.

A study performed by
Suleiman et al of the U.S. Food and Drug Administration
(FDA) on 479 film-chemistry-processor systems in New Jersey
documents these problems. The range of the relative speed
of the processor using the same film ranged from 35 to 210
(100 is the norm). Over 50% of the facilities produced speeds
from 35 to 100. The consequence of under processing is higher
radiation exposure and film contrast degradation.

The settings on the
x-ray equipment tend to drift or go out of calibration over
time. This survey is a means of ensuring that your equipment
is operating properly and that your patients are receiving
the best radiographs at the lowest radiation dose and entrance
skin exposure possible. An annual medical physicist QC survey
is required in the new QA rules.

23.
Why is it important for me to know the entrance skin exposure
(ESE)?

You need to know the
entrance skin exposure (ESE) to be assured you are taking
films that are consistent with the average ESE for that type
of exam. The National Evaluation of X-ray Trends (NEXT) study
shows trends for various radiographic examinations nation
wide. The NEXT studies have been performed by the Conference
of Radiation Control Program Directors (CRCPD) in conjunction
with the Food and Drug Administration for many years and have
produced studies that document downward trends in the amount
of radiation exposure to patients by examination type.
the NEXT data for chest, abdomen, and spine are in the radiographic
Compliance Guidance Document.